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Malaria: ____ cases world wide, most (a little over half) are ____ and in ____.
515 million, non- symptomatic; Africa
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Malaria essentially only effects the ____ hemisphere and the ___
Southern, poor
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Malaria: Pathogenesis
1) Hepatic infection- microorganisms migrate to liver and multiply for 6-15 days (up to 1 yr) 2) red blood cell infection (adhesive proteins stick to blood vessel walls to avoid immune system cycling)
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Malaria: Incubation, Symptoms, Diagnosis, Prognosis
Inc: 6-14 days; Symp: fever, vomiting, convulsions, headache, fatigue, pain, dry cough, enlarged spleen and liver. Diag: symptomology, blood tests Prog: renal failure, 20% mortality rate
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Malaria: Primary, Secondary, Tertiary Prevention
Prim: Insecticide, bed nets, sheets, protective clothing, prophylactic drugs in high risk groups, genetic modification of mosquitoes Secon: Anti- Malarial drugs, hospitalization; Tertiary; primary care, symptom monitoring
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2 Phases of Mosquito Net Distribution
1) populations learn how to use and treat nets (nets cost 15 cents- distr for free) 2) retreatment (wash resistant insecticide in fibers lasts 2-3 years, cheaper chems last 6-12 months)
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Bagamoyo Tanzania Bed Net Project
Nets given to 3 villages (different ethic groups) at 6 mo intervals; 91% had no previous experience with nets or insecticide treatments
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Mixed Cultural Views of Mosquito Nets in Bagamoyo Tanzania Bed Net Project
Dawa: word meaning both a substance used in agr or pest control, often regarded as dangeous and linked to colonial history but also used in traditional healing to refer to an herbal treatment- views motivate non-adherence
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Downfalls of Mosquito Nets (4)
Insecticide wears off even if nets are not actively used, insecticide might be weakened even if other insects are dying, mosquitoes are dangerous even out of season and in small numbers, insecticide has noticeable side effects
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Effects of Fees of Mosquito Net Use
Fees deter adherence, if nearby village gets for free, fees deter even more (low adherence associated with alcoholism)
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Evidence Based Recommendations to Promote ITN Use
CHW undergo special training and edu, community level education programs, alcohol abuse programs, financial resources, transportation to and from clinic, multiple distribution days
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Yellow Fever: Caused by same mosquitoes as ____ and _____; major epidemics in ____ (yrs- 2)and _____ (notable places-2), prevented French from building _____
Dengue, Chikungunya; 1700-1800s; New Orleans, Memphis; Panama Canal
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Yellow Fever: Currently Endemic in ___ and ____
Northern South American (Brazil, Bolivia, Paraguay), Central Africa
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Yellow Fever: Incubation, Symptoms, Diagnosis, Prognosis
3-6 days; fever, headache, nausea; Diag: Blood tests; Progn: 15% of cases enter phase II (jaundice, liver damage, 20% mortality)
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Yellow Fever: Primary, Secondary, Tertiary Prevention
Prim: malaria related prevention measures, vaccination Secon: anti- viral meds (not very effective), hospitalization; Tert: ongoing research
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Dengue Fever: ___ disease transmitted by _____
viral, insects
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Dengue Fever: Incubation, Symptoms, Diagnosis, Prognosis
Incubation: 3-5 days; Sympt: fever, headache, rash, nausea, vomiting; Diag: symptomology, blood tests; Progn: Dengue Shock syndrome is rare, 50% mortality
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Dengue Fever: Primary, Secondary, Tertiary Prevention
Prim: all malaria- related prevention measures; secon; oral rehydration, hospitalization, anti- inflammatory meds; Tert: ongoing research
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Dengue fever is considered an ______. There are ___ cases/ year worldwide but gets much _____ funding.
Underrepresented; 50 million; lower funding than other prominent infectious diseases
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Tuberculosis: High comorbidity with _____,__,___
10% of new cases co- occur with HIV, smokers have relative risk of 10, elderly has highest prevalence in U.S.
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Tuberculosis: ______ cases worldwide, ____ deaths/ year
1.7 billion; 2 million
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TB Has been on a constant rise except during the period of time between __ and ___
~1990 and ~1993
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Tuberculosis (bacteria): Incubation, Symptoms, Diagnosis, Prognosis
Inc: Lifelong Symp: coughing respiratory problems Diag: symptomology, chest x-rays Prog: 5% of all cases become symptomatic, 50% mortality without treatment
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Tuberculosis: Primary, Secondary, Tertiary Prevention
Case identification, vaccination; Secon: Hospitalization, complex antibiotic and med regimes; Tertiary: isolation, DOTS, other kinds of social and ambulatory care
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Predictors of Poor Drug Adherence (6)
Mental illness, drug use, youth, gender, unstable housing, socioeconomic status
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MDRTB makes up _-_% of all cases, __% of recovery chances (__% of all forms of TB), ___% of all MDRTB cases in the developing world.
0-54, 56, 95
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DOTS typically leads to a ___ drug compliance rate and a ___% survival rate
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Without ART: median progression from HIV infection to AIDS is ____, median survival time after developing AIDS is ____
9-10 years; 9-10 months
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With ARTs mortality, AIDS and hospitalizations decreased __-__%, average life expectancy increased ___ years
60-80; 15
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Requirements for Successful ARV Therapies (3)
HIV counseling and psychosocial support, treatment adherence (95% adherence required), $$ (300-1500 in low income countries; $10,000 in U.S.)
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AIDS therapies require an average of ____ pills to be taken each day; patients can only miss __/week
3-5 pills, 5
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DOTS in Boston: Positive effects on these medical factors (6)
total inpatient days (decrease), length of hospital stays, medical costs, effectiveness, drug adherence, long- term decrease in CD4 counts
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Responsibilities of CHWs
Monitor treatment/ deliver drugs, give counsel, provide moral support, educate about prevention, monitor co- morbidity and symptoms
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DOTS in Haiti: Positive Effects
decreased mortality, decreased co- infections, weight gain, decreased days in hospital, increased ability to manage life, job creation (CHWs, Non- medical personnel, others)
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Perinatal Disease Prevention in HIV: __% transmission rate, most HIV+ mothers have ___ and ___
7; prenatal care; effective use of prenatal anti-retroviral therapies
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Reasons for opening (1), closure (1997) of Windham Needle Exchange (5)
115 residents diagnosed with HIV (59% were drug users- 39% white, 43% hispanic); state sponsorship of illegal activity, visible location, strong personalities on staff, advocacy for drug users, sensational reporting on needle problem
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Effects of Windham Needle Exchange Closure (3)
Major increase in users exposed to unreliable needles and drugs, major increase in needle sharing, no decrease in bio- waste
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Texarcana Measles Outbreak (1971-1971): Attack rate in Texaswas ___, attack rate in Arkansas was ____
48.2; 4.2
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Vaccine types (5)
Live organisms (measles, yellow fever, plague), Inactivated or killed organisms (influenza, rabies), cellular fraction (meningitis), recombinant DNC engineering (influenza, hep B), toxoids (tetanus, diptheria, botulism)
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Vaccine: Chain of Events
Primary response, secondary response, immunologic memory
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Vaccines: Primary response
Exposure to antigen, 3-14 day lag, Development of antibodies
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Vaccines: Secondary Response
Booster response, subsequent exposure to antigen, shorter lag period
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Vaccines: Immunologic Memory
Long- term immune response to specific disease
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Diseases whose incidences were greatly reduced by vaccines (4)
Diphtheria, polio, measles, pertussis
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Smallpox eradication required __% worldwide coverage but herd immunity for measles requires __% coverage. __% of U.S. children recieve all vaccines by recommended age
80; 95; 75
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Diptheria: infectious disease in ____ temperatures. ____ experienced epidemics in _____, which led dosages to go from __ to ___ with ____ and ____ coverage.
Cold; USSR; 1980's; 3; 4; boosters; higher (93%)
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Foundations of Expanded Programme of Immunizations (EPI)
1970: fewer than 10% of children have basic immunizations; 1980's: WHO and UNICEF launch EPI, 1990's 80% of children receive basic immuns, preventing 3 million deaths annually
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Diseases eradicated because of EPI
tetanus in pregnant women, polio, measles deaths reduced by 95%
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Global Alliance for Vaccines and Immunizations (GAVI) goals (3)
66% reduction in child mortality in 36 designated countries by 2015, into of under- used vaccines (hepatitis, yellow fever) in developing countries, establish effective and comprehensive immunization programs to be integrated into primary health care systems
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Pertussis (Whooping Cough) ___ disease of the ____ that causes ____ with possible development of _____
bacterial, respiratory tract, cold- like symptoms/ crowing sounds, pneuemonia
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Limitations of pertussis vaccine (4)
Lasts only a few years, allergic reactions (seizures) common, high risk of disease in elderly, cases of permanent brain damage
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Pertussis prevalence has ____ since ____, especially since ____
increased; 1980; 2001
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Wheel of vaccine related lawsuits
Tort litigations--> increased price of vaccine/ malpractice insurance--> National Childhood Vaccine Injury Act (1986)
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The National Childhood Vaccine Injury Act (1986)
Reduced risk of tort litigation related to vaccine related injuries by establishing a claim procedure involving the United States Court of Federal Claims
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Common claims against vaccinations (5)
Side effects (studies limit these), vaccines weaken natural immune response (not proven), risk for diseases (influenza vaccine may increase risk of acquiring Guillain- Barre syndrome), Dangerous chemicals used (some evidence at clinical leve, non at population level), individual freedom (lack of herd immunity requirements puts everyone at risk)
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HPV: ____ annual deaths from cervical cancer; ___% of women in US will have contracted HPV by age 50 (most will remain subclinical); ___ new cases of cervical pre- cancer ever year (Deaths result)
233,00; 80; 250,000 (3,700 deaths)
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Methods to prevent HPV
Pap smear (reduces cervical cancer incidence by 50%), Gardasil, Varvarix, Combo of Gardasil and Varvarix (100%)
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Suggestions for Effective Vaccination Programs (6)
Availability/ effectiveness of vaccine, widespread coverage, community education/ promotion and enrollment programs, assessment of need through surveillance, ongoing evaluation, monitoring of antigenic drift
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